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Olivera-López C, Jiménez-Genchi A, Ortega-Robles D, Valencia-Flores M, Cansino S, Salvador-Cruz J. Polysomnographic parameters associated with cognitive function in patients with major depression and insomnia. CNS Spectr 2024; 29:197-205. [PMID: 38685584 DOI: 10.1017/s1092852924000257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To examine whether objective sleep parameters are associated with cognitive function (CF) in patients with major depressive disorder (MDD) with chronic insomnia (CI) and whether the severity of these disorders is related to CF. METHOD Thirty patients with MDD with CI attending a tertiary care institution underwent two consecutive nights of polysomnographic (PSG) recording and a battery of neuropsychological tests, which included episodic memory, sustained attention, working memory, and executive function. The severity of MDD and CI was assessed by clinical scales. We examined the relationship between PSG parameters and CF, as well as whether the severity of the disorders is related to CF. RESULTS Linear regression analysis revealed that total sleep time (TST) was positively associated with higher learning and recall of episodic memory, as well as better attention. Slow-wave sleep (SWS) showed a positive association with better working memory. Furthermore, wake after sleep onset (WASO) was negatively associated with episodic memory and lower attention. No significant relationships were found between the severity of MDD or CI with CF. CONCLUSION Both sleep duration and depth are positively associated with several aspects of CF in patients with MDD with CI. Conversely, a lack of sleep maintenance is negatively related to CF in these patients. These findings could help identify modifiable therapeutic targets to reduce CF impairment.
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Affiliation(s)
- Carlos Olivera-López
- Laboratory of Sleep Disorders, Faculty of Psychology, National Autonomous University of Mexico, Mexico City, Mexico
- Faculty of Higher Studies Zaragoza, National Autonomous University of Mexico, Mexico City, Mexico
| | - Alejandro Jiménez-Genchi
- Clinical Services Unit, Sleep Clinic, National Institute of Psychiatry "Ramón de la Fuente Muñiz", Mexico City, Mexico
| | - David Ortega-Robles
- Clinical Services Unit, Sleep Clinic, National Institute of Psychiatry "Ramón de la Fuente Muñiz", Mexico City, Mexico
| | - Matilde Valencia-Flores
- Laboratory of Sleep Disorders, Faculty of Psychology, National Autonomous University of Mexico, Mexico City, Mexico
| | - Selene Cansino
- Laboratory of NeuroCognition, Faculty of Psychology, National Autonomous University of Mexico, Mexico City, Mexico
| | - Judith Salvador-Cruz
- Faculty of Higher Studies Zaragoza, National Autonomous University of Mexico, Mexico City, Mexico
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2
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Nyhuis CC, Fernandez-Mendoza J. Insomnia nosology: a systematic review and critical appraisal of historical diagnostic categories and current phenotypes. J Sleep Res 2023; 32:e13910. [PMID: 37122153 DOI: 10.1111/jsr.13910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 05/02/2023]
Abstract
Insomnia nosology has significantly evolved since the Diagnostic and Statistical Manual (DSM)-III-R first distinguished between 'primary' and 'secondary' insomnia. Prior International Classification of Sleep Disorders (ICSD) nosology 'split' diagnostic phenotypes to address insomnia's heterogeneity and the DSM nosology 'lumped' them into primary insomnia, while both systems assumed causality for insomnia secondary to health conditions. In this systematic review, we discuss the historical phenotypes in prior insomnia nosology, present findings for currently proposed insomnia phenotypes based on more robust approaches, and critically appraise the most relevant ones. Electronic databases PsychINFO, PubMED, Web of Science, and references of eligible articles, were accessed to find diagnostic manuals, literature on insomnia phenotypes, including systematic reviews or meta-analysis, and assessments of the reliability or validity of insomnia diagnoses, identifying 184 articles. The data show that previous insomnia diagnoses lacked reliability and validity, leading current DSM-5-TR and ICSD-3 nosology to 'lump' phenotypes into a single diagnosis comorbid with health conditions. However, at least two new, robust insomnia phenotyping approaches were identified. One approach is multidimensional-multimethod and provides evidence for self-reported insomnia with objective short versus normal sleep duration linked to clinically relevant outcomes, while the other is multidimensional and provides evidence for two to five clusters (phenotypes) based on self-reported trait, state, and/or life-history data. Some approaches still need replication to better support whether their findings identify true phenotypes or simply different patterns of symptomatology. Regardless, these phenotyping efforts aim at improving insomnia nosology both as a classification system and as a mechanism to guide treatment.
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Affiliation(s)
- Casandra C Nyhuis
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Julio Fernandez-Mendoza
- Sleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
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3
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Xu JJ, Lin GJ, Fang F, Yu J. Relationship between self-reported sleep and cognitive function: a specification curve analysis. Cogn Process 2023; 24:451-462. [PMID: 36952054 DOI: 10.1007/s10339-023-01133-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
The relationship between self-reported sleep and cognitive function is complex; it is unclear whether self-reported sleep is a robust correlate of people's cognitive function. We address this gap by using a comprehensive large-scale dataset (N = 1054) coupled with a novel modeling approach, specification curve analysis (SCA), to test the association between self-reported sleep and cognitive function. The results of the SCA showed robust correlations between self-reported sleep and cognitive function, with poorer sleep associated with worse cognitive function. Furthermore, the correlations between sleep components and cognitive function were heterogeneous, with differences emerging across cognitive measures and domains. Specifically, daytime dysfunction was associated with the strongest effect on subjective cognitive function, whereas sleep duration and sleep efficiency had the strongest effect on objective cognitive function. Therefore, the relationship between self-reported sleep and cognition depends largely on what and how cognitive function is measured. Our findings guide measurement and domain selection for future research on the role of sleep in cognitive function.
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Affiliation(s)
- Jia-Jie Xu
- Faculty of Psychology, Southwest University, Chongqing, China
| | - Guo-Jun Lin
- Faculty of Psychology, Southwest University, Chongqing, China
| | - Fang Fang
- University-Town Hospital of Chongqing Medical University, Chongqing, China.
| | - Jing Yu
- Faculty of Psychology, Southwest University, Chongqing, China.
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
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4
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Ren D, Jiang B, Guo Z. Insomnia disorder with objective short sleep duration (ISS) phenotype and cognitive performance: a systematic review and meta-analysis. Neurol Sci 2023. [PMID: 36867277 DOI: 10.1007/s10072-023-06692-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
OBJECTIVE Insomnia disorder with objective short sleep duration (ISS) has been considered as a biologically severe subtype. The aim of this meta-analysis was to reveal the association of the ISS phenotype and cognitive performance. METHODS We searched PubMed, EMBASE, and the Cochrane Library for studies that observed an association of cognitive performance and insomnia with objective short sleep duration (ISS) phenotype. The "metafor" and "MAd" packages in R software (version 4.2.0) were used to calculate the unbiased standardized mean difference (Hedge's g), which was adjusted so that a negative value indicated worse cognitive performance. RESULTS The pooled analysis with 1339 participants revealed that the ISS phenotype was associated with overall cognitive impairments (Hedges' g = - 0.56 [- 0.89, - 0.23]), as well as specific cognitive domains including attention (Hedges' g = - 0.86 [- 1.25, - 0.47]), memory (Hedges' g = - 0.47 [- 0.82, - 0.12]), and executive function (Hedges' g = - 0.39 [- 0.76, - 0.02]). However, cognitive performance was not significantly different between insomnia disorder with objective normal sleep duration (INS) and good sleepers (p > .05). CONCLUSION Insomnia disorder with the ISS phenotype, but not the INS phenotype, was associated with cognitive impairments, suggesting the possible utility of treating the ISS phenotype to improve cognitive performance.
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Affiliation(s)
- Dongmei Ren
- Department of Psychology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, 637000, Sichuan, China
| | - Binghu Jiang
- Institute of Brain Function, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, 637000, Sichuan, China.
| | - Zhiwei Guo
- Institute of Brain Function, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, 637000, Sichuan, China
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5
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Associations between objectively measured sleep parameters and cognition in healthy older adults: A meta-analysis. Sleep Med Rev 2023; 67:101734. [PMID: 36577339 DOI: 10.1016/j.smrv.2022.101734] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/03/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
Multiple studies have examined associations between sleep and cognition in older adults, but a majority of these depend on self-reports on sleep and utilize cognitive tests that assess overall cognitive function. The current meta-analysis involved 72 independent studies and sought to quantify associations between objectively measured sleep parameters and cognitive performance in healthy older adults. Both sleep macrostructure (e.g., sleep duration, continuity, and stages) and microstructure (e.g., slow wave activity and spindle activity) were evaluated. For macrostructure, lower restlessness at night was associated with better memory performance (r = 0.43, p = 0.02), while lower sleep onset latency was associated with better executive functioning (r = 0.28, p = 0.03). Greater relative amount of N2 and REM sleep, but not N3, positively correlated with cognitive performance. The association between microstructure and cognition in older adults was marginally significant. This relationship was moderated by age (z = 0.07, p < 0.01), education (z = 0.26, p = 0.03), and percentage of female participants (z = 0.01, p < 0.01). The current meta-analysis emphasizes the importance of considering objective sleep measures to understand the relationship between sleep and cognition in healthy older adults. These results also form a base from which researchers using wearable sleep technology and measuring behavior through computerized testing tools can evaluate their findings.
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Zitser J, Allen IE, Falgàs N, Le MM, Neylan TC, Kramer JH, Walsh CM. Pittsburgh Sleep Quality Index (PSQI) responses are modulated by total sleep time and wake after sleep onset in healthy older adults. PLoS One 2022; 17:e0270095. [PMID: 35749529 PMCID: PMC9232154 DOI: 10.1371/journal.pone.0270095] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 06/04/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To investigate the objective sleep influencers behind older adult responses to subjective sleep measures, in this case, the Pittsburgh Sleep Quality Index (PSQI). Based on previous literature, we hypothesized that SE would be associated with PSQI reported sleep disruption. Furthermore, because SOL increases progressively with age and it tends to be easily remembered by the patients, we also expected it to be one of the main predictors of the perceived sleep quality in the elderly. METHODS We studied 32 cognitively healthy community-dwelling older adults (age 74 ± 0.3 years) who completed an at-home sleep assessment (Zeo, Inc.) and the PSQI. Linear mixed models were used to analyze the association of the objective sleep parameters (measured by the Zeo) with the PSQI total score and sub-scores, adjusting for age, gender, years of education and likelihood of sleep apnea. RESULTS Objective sleep parameters did not show any association with the PSQI total score. We found that objective measures of Wake after sleep onset (WASO, % and min) were positively associated with the PSQI sleep disturbance component, while SE and Total Sleep Time (TST) were negatively associated with PSQI sleep disturbance. Lastly, objective SE was positively associated with PSQI SE. CONCLUSIONS Our findings showed that WASO, SE and TST, are associated with PSQI sleep disturbance, where the greater WASO, overall lower SE and less TST, were associated with increased subjective report of sleep disturbance. As expected, subjective (PSQI) and objective measures of SE were related. However, PSQI total score did not relate to any of the objective measures. These results suggest that by focusing on the PSQI total score we may miss the insight this easily administered self-report tool can provide. If interpreted in the right way, the PSQI can provide further insight into cognitively healthy older adults that have the likelihood of objective sleep disturbance.
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Affiliation(s)
- Jennifer Zitser
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States of America
- Global Brain Health Institute, San Francisco, CA, United States of America
- Movement Disorders Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv-Yafo, Israel
| | - Isabel Elaine Allen
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States of America
- Global Brain Health Institute, San Francisco, CA, United States of America
- Department of Biostatistics and Epidemiology, University of California, San Francisco, CA, United States of America
| | - Neus Falgàs
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States of America
- Global Brain Health Institute, San Francisco, CA, United States of America
| | - Michael M. Le
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States of America
| | - Thomas C. Neylan
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States of America
- Stress & Health Research Program, Department of Mental Health, San Francisco VA Medical Center, San Francisco, CA, United States of America
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States of America
| | - Joel H. Kramer
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States of America
- Global Brain Health Institute, San Francisco, CA, United States of America
- Stress & Health Research Program, Department of Mental Health, San Francisco VA Medical Center, San Francisco, CA, United States of America
| | - Christine M. Walsh
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States of America
- Global Brain Health Institute, San Francisco, CA, United States of America
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Tanlamai U, Jaikengkit AO, Jarutach T, Rajkulchai S, Ritbumroong T. Use of daily posture and activity tracking to assess sedentary behavior, toss-and-turns, and sleep duration of independently living Thai seniors. Health Informatics J 2022; 28:14604582211070214. [DOI: 10.1177/14604582211070214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examines the postures and activities of elders using activity-monitoring device or diary booklet. The research focuses on using the tracked data to assess sedentary behaviors, toss-and-turns, and sleep duration. Fifty seniors participated in the study for 14 days to obtain anecdotal evidence: half of them wore Sookjai, a motion-tracking device; the other half recorded their activities manually via a diary. The results show that they spent most of their time in the sit/stand posture; they tossed and turned during naps and sleep. Both groups showed a similar pattern of activities: the higher level of sedentary behavior is related to a longer sleep duration. Sedentary behavior and naps increased the number of toss-and-turns at night; toss-and-turns did not affect sleep duration. These independent living adults rated themselves healthy regardless of the extent of their sedentary behaviors or tossing and turning. Although the device did not meet all expectations, the seniors did indicate a positive intention to use wearables.
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Affiliation(s)
- Uthai Tanlamai
- Chulalongkorn Business School, Chulalongkorn University, Thailand
| | | | - Trirat Jarutach
- Center of Excellence in Universal Design, Chulalongkorn University, Thailand
| | | | - Thanachart Ritbumroong
- Graduate School of Applied Statistics, National Institute of Development Administration, Thailand
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8
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Cosgrave J, Phillips J, Haines R, Foster RG, Steinsaltz D, Wulff K. Revisiting nocturnal heart rate and heart rate variability in insomnia: A polysomnography-based comparison of young self-reported good and poor sleepers. J Sleep Res 2021; 30:e13278. [PMID: 33622029 PMCID: PMC8577225 DOI: 10.1111/jsr.13278] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/14/2020] [Accepted: 12/28/2020] [Indexed: 01/08/2023]
Abstract
Primary insomnia is often considered a disorder of 24-hr hyperarousal. Numerous attempts have been made to investigate nocturnal heart rate (HR) and its variability (HRV) as potential pathophysiological hallmarks of altered arousal levels in insomnia, with mixed results. We have aimed to overcome some of the pitfalls of previous studies by using a young, medication-free, age- and gender-matched population consisting of 43 students aged 18-30 years half with a subthreshold insomnia complaint. We employed at-home ambulatory polysomnography and compared this attenuated insomnia group to a good sleeping group. The poor sleepers had significantly higher wake after sleep onset, arousal count, mean HR in all sleep stages (with the exception of Stage 1) and lower sleep efficiency. Consistent with previous research, we also found a significant group-by-sleep stage interaction in the prediction of nocturnal HR, highlighting the insomnia group to have a lower wake-sleep HR reduction compared to good sleepers. When restricting our analyses to insomnia with objectively determined short sleep duration, we found significantly lower standard deviation of RR intervals (SDNN; a measure of HRV) compared to good sleepers. Taken together, this lends credence to the hyperarousal model of insomnia and may at least partially explain the increased prevalence of cardiovascular morbidity and mortality observed in patients with insomnia.
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Affiliation(s)
- Jan Cosgrave
- Sleep and Circadian Neuroscience InstituteNDCNThe Sir William Dunn School of PathologyUniversity of OxfordOxfordUK
- Department of Clinical, Educational and Health PsychologyUniversity College LondonLondonUK
| | | | - Ross Haines
- Department of StatisticsUniversity of OxfordOxfordUK
| | - Russell G. Foster
- Sleep and Circadian Neuroscience InstituteNDCNThe Sir William Dunn School of PathologyUniversity of OxfordOxfordUK
| | - David Steinsaltz
- Department of Clinical, Educational and Health PsychologyUniversity College LondonLondonUK
| | - Katharina Wulff
- Departments of Radiation Sciences and Molecular BiologyUmeå UniversityUmeåSweden
- Wallenberg Centre for Molecular Medicine (WCMM)Umeå UniversityUmeåSweden
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9
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Scarlett S, Kenny RA, O'Connell MD, Nolan H, de Looze C. Associations between cognitive function, actigraphy-based and self-reported sleep in older community-dwelling adults: Findings from the Irish Longitudinal Study on Ageing. Int J Geriatr Psychiatry 2021; 36:731-742. [PMID: 33185299 DOI: 10.1002/gps.5473] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/01/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Cognitive impairment is prevalent in older ages. Associations with sleep are well established; however, ambiguity remains in which sleep characteristics contribute to this impairment. We examined cross-sectional associations between both self-reported and actigraphy-based sleep and cognitive performance across a number of domains in community-dwelling older adults. METHODS 1520 participants aged 50 and older with self-reported and actigraphy-based total sleep time (TST) (≤5, 6, 7-8, 9 and ≥10 h) and self-reported sleep problems were analysed. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), verbal fluency, immediate and delayed recall memory, colour trails tests, and choice reaction tests (CRT). Associations between sleep and cognition were modelled using linear and negative binomial regression. RESULTS Negative associations were found between ≥10 h of self-reported TST and MoCA error rate (incidence rate ratio [IRR] = 1.42; 95% confidence interval [CI] = 1.18, 1.71; p < 0.001); verbal fluency (beta [B] = -2.32 words; 95% CI = -4.00, -0.65; p < 0.01); and delayed recall (B = -0.91 words; 95% CI = -1.58, -0.25; p < 0.05) compared to 7-8 h. Significant associations with actigraphy-based TST were limited to MoCA error rate in ≤5 h (IRR = 1.22; 95% CI = 1.02, 1.45; p < 0.05) compared to 7-8 h. Higher numbers of sleep problems were associated with slower performance in CRT cognitive response time (IRR = 1.02; 95% CI = 1.00, 104; p < 0.05) and total response time (IRR = 1.02; 95% CI = 1.00, 1.04; p < 0.05). CONCLUSIONS Self-reported long sleep duration was consistently associated with worse cognitive performance across multiple domains. Marginal associations between cognition and both actigraphy-based sleep and self-reported sleep problems were also apparent. These results further affirm poor sleep as a risk factor for cognitive impairment.
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Affiliation(s)
- Siobhan Scarlett
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, University of Dublin, Dublin, Ireland.,Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Matthew Dl O'Connell
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, University of Dublin, Dublin, Ireland.,Department of Population Health Sciences, School of Population Health and Environmental Sciences, Kings College London, London, UK
| | - Hugh Nolan
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Céline de Looze
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, University of Dublin, Dublin, Ireland
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Fernandez-Mendoza J, He F, Puzino K, Amatrudo G, Calhoun S, Liao D, Vgontzas AN, Bixler E. Insomnia with objective short sleep duration is associated with cognitive impairment: a first look at cardiometabolic contributors to brain health. Sleep 2021; 44:5908888. [PMID: 32968796 DOI: 10.1093/sleep/zsaa150] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/27/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES Insomnia with objective short sleep duration has been previously associated with adverse cardiometabolic health outcomes as well as poorer cognitive performance in otherwise noncognitively impaired adults. However, studies demonstrating an increased prevalence of cognitive impairment (CI) in this insomnia phenotype are lacking. METHODS We analyzed data from Penn State Adult Cohort (N = 1,524; 48.9 ± 13.4 years; 53.4% women). Self-reported sleep difficulty was defined as normal sleep (n = 899), poor sleep (n = 453), and chronic insomnia (n = 172). Objective short sleep duration was defined as less than 6-h of sleep, based on in-lab, 8-h polysomnography. CI (n = 155) and possible vascular cognitive impairment (pVCI, n = 122) were ascertained using a comprehensive neuropsychological battery. Analyses adjusted for age, sex, race, education, body mass index, apnea/hypopnea index, smoking, alcohol, psychoactive medication, and mental and physical health problems. RESULTS Participants who reported poor sleep or chronic insomnia and slept objectively less than 6 hours were associated with a 2-fold increased odds of CI (OR = 2.06, 95% confidence limits [CL] = 1.15-3.66 and OR = 2.18, 95% CL = 1.07-4.47, respectively) and of pVCI (OR = 1.94, 95% CL = 1.01-3.75 and OR = 2.33, 95% CL = 1.07-5.06, respectively). Participants who reported poor sleep or chronic insomnia and slept objectively more than 6 hours were not associated with increased odds of either CI (OR = 0.72, 95% CL = 0.30-1.76 and OR = 0.75, 95% CL = 0.21-2.71, respectively) or pVCI (OR = 1.08, 95% CL = 0.42-2.74 and OR = 0.76, 95% CL = 0.16-3.57, respectively). CONCLUSIONS Insomnia with objective short sleep duration is associated with an increased prevalence of CI, particularly as it relates to cardiometabolic health (i.e. pVCI). These data further support that this insomnia phenotype may be a more biologically severe form of the disorder associated with cardiovascular, cerebrovascular, and neurocognitive morbidity.
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Affiliation(s)
- Julio Fernandez-Mendoza
- Sleep Research and Treatment Center, Department of Psychiatry & Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA
| | - Fan He
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA
| | - Kristina Puzino
- Sleep Research and Treatment Center, Department of Psychiatry & Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA
| | - Gregory Amatrudo
- Sleep Research and Treatment Center, Department of Psychiatry & Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA
| | - Susan Calhoun
- Sleep Research and Treatment Center, Department of Psychiatry & Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA
| | - Duanping Liao
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA
| | - Alexandros N Vgontzas
- Sleep Research and Treatment Center, Department of Psychiatry & Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA
| | - Edward Bixler
- Sleep Research and Treatment Center, Department of Psychiatry & Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA
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11
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Elías MN, Munro CL, Liang Z. Daytime-to-Nighttime Sleep Ratios and Cognitive Impairment in Older Intensive Care Unit Survivors. Am J Crit Care 2021; 30:e40-e47. [PMID: 33644810 PMCID: PMC10467820 DOI: 10.4037/ajcc2021221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Sleep duration and proportion of daytime versus nighttime sleep may affect cognitive function in older patients in the transition out of the intensive care unit. OBJECTIVE To explore the relationship between the daytime-to-nighttime sleep ratio and cognitive impairment in older intensive care unit survivors. METHODS The study enrolled 30 older adults within 24 to 48 hours after intensive care unit discharge. All participants were functionally independent before admission and underwent mechanical ventilation in the intensive care unit. Actigraphy was used to estimate daytime (6 AM to 9:59 PM) and nighttime (10 PM to 5:59 AM) total sleep duration. Daytime-to-nighttime sleep ratios were calculated by dividing the proportion of daytime sleep by the proportion of nighttime sleep. The National Institutes of Health Toolbox Cognition Battery Dimensional Change Card Sort Test (DCCST) was used to assess cognition. Associations between sleep and cognition were explored using multivariate regression after adjusting for covariates. RESULTS The mean (SD) daytime sleep duration was 7.55 (4.30) hours (range, 0.16-14.21 hours), and the mean (SD) nighttime sleep duration was 4.99 (1.95) hours (range, 0.36-7.21 hours). The mean (SD) daytime-to-nighttime sleep ratio was 0.71 (0.30) (range, 0.03-1.10). Greater daytime sleep duration (β = -0.351, P = .008) and higher daytime-to-nighttime sleep ratios (β = -0.373, P = .008) were negatively associated with DCCST scores. CONCLUSIONS The daytime-to-nighttime sleep ratio was abnormally high in the study population, revealing an altered sleep/wake cycle. Higher daytime-to-nighttime sleep ratios were associated with worse cognition, suggesting that proportionally greater daytime sleep may predict cognitive impairment.
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Affiliation(s)
- Maya N Elías
- Maya N. Elías is a postdoctoral research fellow, School of Nursing and Health Studies, University of Miami, Coral Gables, Florida
| | - Cindy L Munro
- Cindy L. Munro is dean and a professor, School of Nursing and Health Studies, University of Miami, Coral Gables, Florida
| | - Zhan Liang
- Zhan Liang is an assistant professor, School of Nursing and Health Studies, University of Miami, Coral Gables, Florida
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12
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Guan Q, Hu X, Ma N, He H, Duan F, Li X, Luo Y, Zhang H. Sleep Quality, Depression, and Cognitive Function in Non-Demented Older Adults. J Alzheimers Dis 2020; 76:1637-1650. [DOI: 10.3233/jad-190990] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Qing Guan
- Center for Brain Disorder and Cognitive Science, Shenzhen University, Shenzhen, China
- Center for Neuroimaging, Shenzhen Institute of Neuroscience, Shenzhen, China
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Xiaohui Hu
- Center for Brain Disorder and Cognitive Science, Shenzhen University, Shenzhen, China
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Ning Ma
- Center for Sleep Research, School of Psychology, South China Normal University, Guangzhou, China
| | - Hao He
- Center for Brain Disorder and Cognitive Science, Shenzhen University, Shenzhen, China
- Center for Neuroimaging, Shenzhen Institute of Neuroscience, Shenzhen, China
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Feiyan Duan
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Xin Li
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, P. R. China
| | - Yuejia Luo
- Center for Brain Disorder and Cognitive Science, Shenzhen University, Shenzhen, China
- Center for Neuroimaging, Shenzhen Institute of Neuroscience, Shenzhen, China
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Haobo Zhang
- Center for Brain Disorder and Cognitive Science, Shenzhen University, Shenzhen, China
- Center for Neuroimaging, Shenzhen Institute of Neuroscience, Shenzhen, China
- School of Psychology, Shenzhen University, Shenzhen, China
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13
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Kimura N, Aso Y, Yabuuchi K, Ishibashi M, Hori D, Sasaki Y, Nakamichi A, Uesugi S, Jikumaru M, Sumi K, Eguchi A, Obara H, Kakuma T, Matsubara E. Association of Modifiable Lifestyle Factors With Cortical Amyloid Burden and Cerebral Glucose Metabolism in Older Adults With Mild Cognitive Impairment. JAMA Netw Open 2020; 3:e205719. [PMID: 32515796 PMCID: PMC7284299 DOI: 10.1001/jamanetworkopen.2020.5719] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Understanding the association of lifestyle factors with mild cognitive impairment enables the development of evidence-based interventions for delaying cognitive impairment. OBJECTIVE To explore whether objectively measured lifestyle factors, such as physical activity, conversation, and sleep, are associated with cortical amyloid burden and cerebral glucose metabolism in older adults with mild cognitive impairment. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 855 community-dwelling adults in Usuki, Oita Prefecture, Japan, aged 65 years or older. Data were collected from August 2015 to December 2017. Participants were reviewed to examine risk and protective lifestyle factors for dementia. Data analysis was conducted in June 2019. EXPOSURES Wearable sensors, carbon-11 labeled Pittsburgh compound B positron emission tomography images, and fluorine-18 fluorodeoxyglucose positron emission tomography images. MAIN OUTCOMES AND MEASURES Wearable sensor data, such as walking steps, conversation time, and sleep, were collected from August 2015 to October 2017, and positron emission tomography images were collected from October 2015 to December 2017. A multiple regression model and change-point regression model were used to examine the association of lifestyle factors with mean amyloid or fluorodeoxyglucose uptake, assessed on the basis of a standardized uptake value ratio of the frontal lobes, temporoparietal lobes, and posterior cingulate gyrus with the cerebellar cortex as the reference region. The bootstrap method was used to obtain nonparametric 95% CIs on the associations of lifestyle factors with cognitive decline. RESULTS Of the 855 adults in the study, 118 (13.8%) were diagnosed with mild cognitive impairment, with a mean (SD) age of 75.7 (5.8) years and 66 (55.9%) women. Total sleep time was inversely associated with fluorodeoxyglucose uptake after adjusting for covariates (β = -0.287; 95% CI, -0.452 to -0.121, P < .001). Change-point regression showed an inverse association between total sleep time and mean amyloid uptake when sleep duration was longer than 325 minutes (B = -0.0018; 95% CI, -0.0031 to -0.0007). CONCLUSIONS AND RELEVANCE To our knowledge, this is the first study to demonstrate that total sleep time was associated with brain function in older adults with mild cognitive impairment. Sleep duration is a potentially modifiable risk factor for dementia at the mild cognitive impairment stage.
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Affiliation(s)
- Noriyuki Kimura
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Yasuhiro Aso
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Kenichi Yabuuchi
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Masato Ishibashi
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Daiji Hori
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Yuuki Sasaki
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Atsuhito Nakamichi
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Souhei Uesugi
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Mika Jikumaru
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Kaori Sumi
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Atsuko Eguchi
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | | | | | - Etsuro Matsubara
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
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14
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Abstract
OBJECTIVE To investigate the specific effect of insomnia on neuropsychological functioning in patients with very complex chronic pain. BACKGROUND Individuals with insomnia disorder or chronic pain often experience cognitive deficits, with both conditions appearing to correlate with impairments in neuropsychological functions. As insomnia often occurs comorbid with chronic pain, distinguishing the differential effects of these two syndromes on an individual's neuropsychological functioning can be challenging. Comorbid depressive symptoms in these individuals, which may also affect cognitive function, may further obscure the associations between chronic pain, insomnia, and the neuropsychological profile. METHODS The neuropsychological function of 22 individuals with very complex chronic pain was assessed using specialized tests examining aspects of memory and executive functioning. The severity of insomnia, depression, and anxiety was measured using questionnaires, and pain levels were assessed using a visual analog scale. Pain medications were transformed to the morphine-equivalent daily dose. RESULTS Insomnia severity was found to predict memory function, accounting for 32.4% of the variance: A 1 SD increase in insomnia severity decreased memory function by 0.57 SD. The negative correlation between insomnia and memory was significant even after controlling for pain level, morphine-equivalent daily dose, and comorbid levels of anxiety and depression. CONCLUSIONS Insomnia severity independently predicted memory function in patients with very complex chronic pain, even after controlling for other factors known to impair cognitive function. Insomnia may possibly explain some of the cognitive impairments related to chronic pain; thus, screening for, and treating, sleep disturbances may be a central aspect of chronic pain rehabilitation.
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15
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Kimura N, Aso Y, Yabuuchi K, Ishibashi M, Hori D, Sasaki Y, Nakamichi A, Uesugi S, Fujioka H, Iwao S, Jikumaru M, Katayama T, Sumi K, Eguchi A, Nonaka S, Kakumu M, Matsubara E. Modifiable Lifestyle Factors and Cognitive Function in Older People: A Cross-Sectional Observational Study. Front Neurol 2019; 10:401. [PMID: 31068892 PMCID: PMC6491512 DOI: 10.3389/fneur.2019.00401] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 04/02/2019] [Indexed: 12/17/2022] Open
Abstract
Background: The development of evidence-based interventions for delaying or preventing cognitive impairment is an important challenge. Most previous studies using self-report questionnaires face problems with reliability and consistency due to recall bias or misclassification among older people. Therefore, objective measurement of lifestyle components is needed to confirm the relationships between lifestyle factors and cognitive function. Aims: The current study examined the relationship between lifestyle factors collected with wearable sensors and cognitive function among community-dwelling older people using machine learning. Methods: In total, 855 participants (mean age: 73.8 years) wore a wristband sensor for 7.8 days on average every 3 months. Various lifestyle parameters were measured, including walking steps, conversation time, total sleep time (TST), sleep efficiency, time awake after sleep onset, awakening count, napping time, and heart rate. Random forest (RF) regression analysis was used to examine the relationships between total daily sensing data and Mini-Mental State Examination (MMSE) scores. Confounding factor analysis was conducted with models that were adjusted and unadjusted for demographic and vascular risk factors, and selected variables were assessed as risk and protective factors using partial dependence plots (PDPs). Results: Lifestyle data were collected for 31.3 ± 7.1 days per year using wristband sensors. RF regression analysis adjusted for age, gender, and education levels selected four variables, including number of walking steps, conversation time, TST, and heart rate. Moreover, walking steps, conversation time, and heart rate remained after RF regression analysis adjusted for demographic and vascular risk factors. Number of walking steps, conversation time, and heart rate were categorized as protective factors, whereas TST was categorized as a risk factor for cognitive function. Although PDPs of number of walking steps and heart rate revealed continuously increased MMSE scores, those of conversation time and TST and revealed that the tendency in the graph was reversed at the boundary of a particular threshold (321.1 min for conversation time, 434.1 min for TST). Conclusions: Lifestyle factors, such as physical activity, sleep, and social activity appear to be associated with cognitive function among older people. Physical activity and appropriate durations of sleep and conversation are important for cognitive function.
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Affiliation(s)
- Noriyuki Kimura
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Yasuhiro Aso
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Kenichi Yabuuchi
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Masato Ishibashi
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Daiji Hori
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Yuuki Sasaki
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Atsuhito Nakamichi
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Souhei Uesugi
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Hideyasu Fujioka
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Shintaro Iwao
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Mika Jikumaru
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Tetsuji Katayama
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Kaori Sumi
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | - Atsuko Eguchi
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
| | | | | | - Etsuro Matsubara
- Department of Neurology, Faculty of Medicine, Oita University, Oita, Japan
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16
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Rouine J, Callaghan CK, O'Mara SM. Opioid modulation of depression: A focus on imaging studies. PROGRESS IN BRAIN RESEARCH 2018; 239:229-252. [PMID: 30314568 DOI: 10.1016/bs.pbr.2018.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Depression is the leading cause of disability worldwide, with over 300 million people affected. Almost all currently available antidepressant treatments target monoamine neurotransmitter systems and have a delayed onset of action up to several weeks that can be associated with low rates of treatment response. The endogenous opioid system has been identified as a potential target for the development of novel antidepressants due to its high opioid receptor concentrations in central limbic areas that are also implicated in physiological processes including regulation of mood and emotion. Genetic depletion, pharmacological manipulation, and preclinical models have been widely used to characterize the role of opioid transmission in depressive states. Neuroimaging studies have been carried out in clinical populations to investigate opioid transmission in mood and emotion in an attempt to identify those regional anatomical and functional brain changes that are associated with depression. Great insight has been provided into the cerebral structural and functional changes associated with depression but there remains a need to tie the functional theories of depression to anatomical localization and further neuroimaging studies are best placed to do this.
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Affiliation(s)
- Jennifer Rouine
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland.
| | - Charlotte K Callaghan
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland
| | - Shane M O'Mara
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland
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